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More isn’t always better in medicine

Editorial

There’s an old adage we all have heard: Just because one pill is good for you, it doesn’t mean two pills are better.

Quality, we learn when its comes to medications, trumps quantity. Taking a medication as prescribed by a doctor can have the desired positive impact on your health. Take too much of the wrong medication and bad things can happen, including overdose and death.

According to a report last week from the professional societies of 17 medical specialties, that can hold true for medical tests as well. Getting the newest medical tests available and more of them isn’t the healthiest approach.

The societies are part of the a campaign known as Choosing Wisely, which has been reviewing medical tests, treatments and procedures that have been in place for years, even decades. The organization has found 135 of those tests, treatments and procedures that are usually unnecessary and often harmful.

The American Board of Internal Medicine foundation organized Choosing Wisely as a mechanism for encouraging physicians to stop performing ineffective procedures as a matter of routine.

“Americans’ view of health care is that more is better,” Dr. Glenn Stream, of Spokane, Wash., the board chairman of the American Academy of Family Physicians, told Reuters news service. “But there are a lot of things that are done frequently but don’t contribute to people’s health and may be harmful.”

Indeed, there was a time when doctors were much too quick to give a sick child a shot of penicillin, even though the antibiotic wasn’t necessary. Often the injections served more to soothe the emotions of a parent who demanded that something be done than to ease symptoms in the young patient. Now, we’re finding penicillin resistant bacteria that developed much more quickly than they would have had there been a more judicious use of antibiotics in previous decades.

And as society has gotten ever more litigious, it’s hard to blame a doctor who will order a battery of tests, regardless of how much benefit he or she expects to derive from the subsequent data, to ensure that he or she is not hauled into court for letting something that “should have been caught” slip by.

According to the Reuters report, the cost of the tests were not a consideration in the lists the medical specialty groups compiled, which is reassuring. While a reduction in tests most assuredly would save money for patients and health insurers, the bottom line on the worthiness of a test or procedure should be its value in helping improve a health outcome for a patient.

It was also reassuring that the organization did not say the tests and procedures should be done away with altogether. Even if a test is deemed to be unlikely to have a benefit for a patient group in general, that doesn’t mean it won’t help a specific patient with a particular set of circumstances. For instance, the American Academy of Pediatrics says that CT scans for a child who has suffered a mild head injury should at least be questioned by a physician because it doesn’t improve diagnosis and carries some cancer risk. But of the doctor suspects something unusual, that CT scan very well may be something that should be conducted.

Medical science has made some wonderful advances. Much of what we take for granted today — MRIs, CT scans, even nearly instant glucose readings on finger sticks — were science fiction a half-century ago. But technology can only do so much. The American health care to be what it should be, its core has to reside in truthful communication between a patient and the doctor he or she trusts.

Comments

FryarTuk 1 year, 6 months ago

"More isn’t always better in medicine" when it comes to choices for care and treatment more is most always better.

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